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    <head>
        <meta charset="utf-8">
        <title>Digital-Center Backend System</title>
        <meta name="description" content="mobile first, app, web app, responsive, admin dashboard, flat, flat ui">
        <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1">	
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    <body>
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            <a href="<?php echo base_url('frontend/application/pdf/1'); ?>" target="_blank">
                <img id="logo" src="<?php echo base_url('assets/img/application/logo.png'); ?>" width="100" />
            </a>
        </div>

        <header id="header">
            <h1>APPLICATION FORM</h1>
            <h3>Bachelor of Science (International Program)<br/>
                Faculty of Science and Technology, Thammasat University<br/>
                Klong Luang, Pathumthani, 12120, Thailand. Tel. +66 2 564-4495</h3>      
        </header>
        <div id="box_no">For official use only<br/>
            Application No.<span><?php echo isset($application_no) ? $application_no : ''; ?>&nbsp;</span>
        </div>      
        <div class="head_line"></div>
        <div class="head_line"></div>

        <h1 class="page-header">Part I. Study Program <small>applicant may choose to apply to 1 or more programs</small></h1>
        <h3 class="tab1 line">Please rank the Program in order to apply for  (1 being the most desirable, 3 the least)  </h3>

        <div class="form-group">
            <div class="col-lg-6 control-label tab2 line">Creative Digital Technology (CDT)</div>
            <div class="col-lg-4 line">
                <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($cdt_rank) && $cdt_rank == '1' ? 'checked="checked"' : ''; ?>> 1
                <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($cdt_rank) && $cdt_rank == '2' ? 'checked="checked"' : ''; ?>> 2
                <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($cdt_rank) && $cdt_rank == '3' ? 'checked="checked"' : ''; ?>> 3
            </div>
            <div class="col-lg-6 control-label tab2 line">Innovative Digital Design (IDD)</div>
            <div class="col-lg-4 line">
                <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($did_rank) && $did_rank == '1' ? 'checked="checked"' : ''; ?>> 1
                <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($did_rank) && $did_rank == '2' ? 'checked="checked"' : ''; ?>> 2
                <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($did_rank) && $did_rank == '3' ? 'checked="checked"' : ''; ?>> 3
            </div>
            <div class="col-lg-6 control-label tab2 line">Industrial Science and Management (ISc)</div>
            <div class="col-lg-4 line">
                <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($isc_rank) && $isc_rank == '1' ? 'checked="checked"' : ''; ?>> 1
                <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($isc_rank) && $isc_rank == '2' ? 'checked="checked"' : ''; ?>> 2
                <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($isc_rank) && $isc_rank == '3' ? 'checked="checked"' : ''; ?>> 3
            </div>
        </div>
        <div class="form-group">
            <h1 class="page-header">Part II. Personal Information</h1>
            <h3 class="line  clear">1) Applicant’s name</h3>
            <div class="col-lg-3 line tab1">In English</div>
            <div class="col-lg-7 line"><div class="input"><?php echo isset($name_en) ? $name_en : ''; ?>&nbsp;</div></div>
            <div class="col-lg-3 line tab1">In Thai</div>
            <div class="col-lg-7 line"><div class="input"><?php echo isset($name_th) ? $name_th : ''; ?>&nbsp;</div></div>
            <div class="col-lg-5">
                <div class="line" style="width: 245px;">2) Date of Birth (Day/Month/Year) :</div> 
                <div class="input"  style="width: 85px;"><?php echo isset($birthday) ? $birthday : ''; ?>&nbsp;</div></div>
            <div class="col-lg-5">
                <div class="line" style="width: 112px;">3) Nationality: </div>
                <div class="input"  style="width: 227px;"><?php echo isset($nationality) ? $nationality : ''; ?>&nbsp;</div>
            </div>
            <div class="col-lg-5 line">
                <div class="line" style="width: 90px;">4) Gender: </div>
                <div class="line" style="width: 170px;">
                    <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($gender) && $gender == 'male' ? 'checked="checked"' : ''; ?>> Male
                    <input type="checkbox" name="cdt_rank" value="1" <?php echo isset($gender) && $gender == 'female' ? 'checked="checked"' : ''; ?>> Female
                </div>
            </div>
            <div class="col-lg-5">
                <div class="line" style="width: 92px;">5) Religion: </div>
                <div class="input"  style="width: 247px;"><?php echo isset($religion) ? $religion : ''; ?>&nbsp;</div>
            </div>
            <div class="clear"></div>
            <div class="col-lg-2 line">6) Citizenship:</div>
            <div class="col-lg-8 line">
                <div class="line" style="width: 60px;"><input type="checkbox" <?php echo isset($citizenship) && $citizenship == 'thai' ? 'checked="checked"' : ''; ?>/> Thai: </div>
                <div class="input" style="width: 478px;"><?php echo isset($citizen_id) ? $citizen_id : ''; ?>&nbsp;</div>
                <div class="clear"></div>
                <div class="line" style="width: 62px;"><input type="checkbox" <?php echo isset($citizenship) && $citizenship == 'other' ? 'checked="checked"' : ''; ?>/> Other: </div>
                <div class="line" style="width: 163px;">Country of Citizenship: </div>
                <div class="input" style="width: 111px;"><?php echo isset($citizenship_of) ? $citizenship_of : ''; ?>&nbsp;</div> 
                <div class="line" style="width: 97px;">Passport No.: </div>
                <div class="input" style="width: 105px;"><?php echo isset($passport_no) ? $passport_no : ''; ?>&nbsp;</div>        
            </div>
            <div class="clear line">
                <div class="line" style="width: 163px;">7) Permanent address: </div>
                <div class="input" style="width: 517px;"><?php echo isset($permanent_address) ? $permanent_address : ''; ?>&nbsp;</div>  
            </div>
            <div class="col-lg-5 line">
                <div class="line" style="width: 103px;">Telephone: </div>
                <div class="input" style="width: 207px;"><?php echo isset($telephone) ? $telephone : ''; ?>&nbsp;</div>  
            </div>
            <div class="col-lg-5 line">
                <div class="line" style="width: 103px;">Mobile phone: </div>
                <div class="input" style="width: 230px;"><?php echo isset($mobilephone) ? $mobilephone : ''; ?>&nbsp;</div>  
            </div>
            <div class="clear line">
                <div class="line" style="width: 262px;">Mailing address <small>(if different from above)</small>:</div>
                <div class="input" style="width: 418px;"><?php echo isset($mailing_address) ? $mailing_address : ''; ?>&nbsp;</div>  
            </div>
            <div class="col-lg-5 line">
                <div class="line" style="width: 103px;">Telephone: </div>
                <div class="input" style="width: 207px;"><?php echo isset($telephone2) ? $telephone2 : ''; ?>&nbsp;</div>  
            </div>
            <div class="col-lg-5 line">
                <div class="line" style="width: 123px;">E-mail address: </div>
                <div class="input" style="width: 210px;"><?php echo isset($email) ? $email : ''; ?>&nbsp;</div>  
            </div>

            <div class="clear line">
                <div class="line" style="width: 140px;">8) Father’s name:  </div>
                <div class="input" style="width: 540px;"><?php echo isset($father_name) ? $father_name : ''; ?>&nbsp;</div> 
            </div>
            <div class="col-lg-4 line">
                <div class="line" style="width: 103px;">Occupation: </div>
                <div class="input" style="width: 160px;"><?php echo isset($father_occupation) ? $father_occupation : ''; ?>&nbsp;</div>  
            </div>
            <div class="col-lg-6 line">
                <div class="line" style="width: 180px;">Organization/Company: </div>
                <div class="input" style="width: 227px;"><?php echo isset($father_company) ? $father_company : ''; ?>&nbsp;</div>  
            </div>

            <div class="col-lg-4 line">
                <div class="line" style="width: 103px;">Telephone: </div>
                <div class="input" style="width: 160px;"><?php echo isset($father_telephone) ? $father_telephone : ''; ?>&nbsp;</div>  
            </div>
            <div class="col-lg-6 line">
                <div class="line" style="width: 120px;">E-mail address: </div>
                <div class="input" style="width: 287px;"><?php echo isset($father_email) ? $father_email : ''; ?>&nbsp;</div>  
            </div>

            <div class="clear line">
                <div class="line" style="width: 140px;">9) Mother’s name:  </div>
                <div class="input" style="width: 540px;"><?php echo isset($mother_name) ? $mother_name : ''; ?>&nbsp;</div> 
            </div>
            <div class="col-lg-4 line">
                <div class="line" style="width: 103px;">Occupation: </div>
                <div class="input" style="width: 160px;"><?php echo isset($mother_occupation) ? $mother_occupation : ''; ?>&nbsp;</div>  
            </div>
            <div class="col-lg-6 line">
                <div class="line" style="width: 180px;">Organization/Company: </div>
                <div class="input" style="width: 227px;"><?php echo isset($mother_company) ? $mother_company : ''; ?>&nbsp;</div>  
            </div>

            <div class="col-lg-4 line">
                <div class="line" style="width: 103px;">Telephone: </div>
                <div class="input" style="width: 160px;"><?php echo isset($mother_telephone) ? $mother_telephone : ''; ?>&nbsp;</div>  
            </div>
            <div class="col-lg-6 line">
                <div class="line" style="width: 120px;">E-mail address: </div>
                <div class="input" style="width: 287px;"><?php echo isset($mother_email) ? $mother_email : ''; ?>&nbsp;</div>  
            </div>



            <div class="clear line">
                <div class="line" style="width: 150px;">10) Gaurdian’s name:  </div>
                <div class="input" style="width: 530px;"><?php echo isset($gaurdian_name) ? $gaurdian_name : ''; ?>&nbsp;</div> 
            </div>
            <div class="col-lg-4 line">
                <div class="line" style="width: 103px;">Occupation: </div>
                <div class="input" style="width: 160px;"><?php echo isset($gaurdian_occupation) ? $gaurdian_occupation : ''; ?>&nbsp;</div>  
            </div>
            <div class="col-lg-6 line">
                <div class="line" style="width: 180px;">Organization/Company: </div>
                <div class="input" style="width: 227px;"><?php echo isset($gaurdian_company) ? $gaurdian_company : ''; ?>&nbsp;</div>  
            </div>

            <div class="col-lg-4 line">
                <div class="line" style="width: 103px;">Telephone: </div>
                <div class="input" style="width: 160px;"><?php echo isset($gaurdian_telephone) ? $gaurdian_telephone : ''; ?>&nbsp;</div>  
            </div>
            <div class="col-lg-6 line">
                <div class="line" style="width: 120px;">E-mail address: </div>
                <div class="input" style="width: 287px;"><?php echo isset($gaurdian_email) ? $gaurdian_email : ''; ?>&nbsp;</div>  
            </div>


            <div class="clear"></div>
            <h1 class="page-header" style="margin: 0px; padding: 0px;">Part III. Academic records</h1>
            <h3 class="line">11) Please provide full details of schools/colleges currently and previously attended (most recent first).</h3>

            <div class="clear">
                <table class="nomal_table">
                    <tr>
                        <th>Level<br/>(M6, IB <br/>IGCSE, etc.)</th>
                        <th>Language<br/> of <br/>Instruction</th>
                        <th>Institution<br/>(Name, City, and Country)</th>
                        <th>Major</th>
                        <th>CGPA<br/>/GPX</th>
                        <th>From<br/><small>(Month/Year)</small></th>
                        <th>To<br/><small>(Month/Year)</small></th>
                    </tr>
                    <tr>
                        <td><?php echo isset($academic_level_1) ? $academic_level_1 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_language_1) ? $academic_language_1 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_institution_1) ? $academic_institution_1 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_major_1) ? $academic_major_1 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_gpa_1) ? $academic_gpa_1 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_from_1) ? $academic_from_1 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_to_1) ? $academic_to_1 : ''; ?>&nbsp;</td>
                    </tr>
                    <tr>
                        <td><?php echo isset($academic_level_2) ? $academic_level_2 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_language_2) ? $academic_language_2 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_institution_2) ? $academic_institution_2 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_major_2) ? $academic_major_2 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_gpa_2) ? $academic_gpa_2 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_from_2) ? $academic_from_2 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_to_2) ? $academic_to_2 : ''; ?>&nbsp;</td>
                    </tr>
                    <tr>
                        <td><?php echo isset($academic_level_3) ? $academic_level_3 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_language_3) ? $academic_language_3 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_institution_3) ? $academic_institution_3 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_major_3) ? $academic_major_3 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_gpa_3) ? $academic_gpa_3 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_from_3) ? $academic_from_3 : ''; ?>&nbsp;</td>
                        <td><?php echo isset($academic_to_3) ? $academic_to_3 : ''; ?>&nbsp;</td>
                    </tr>
                </table>
                <div class="clear">
                    <div class="line" style="width: 100%;">Awards, scholarships or prizes  <small>(if any)</small>:</div>
                    <div class="input" style="width: 100%;"><?php echo isset($awards) ? $awards : ''; ?>&nbsp;</div>  
                </div>
                <div class="clear">
                    <div class="line" style="width: 100%;">List any organization, community activities, or extracurricular activities:</div>
                    <div class="input" style="width: 100%;"><?php echo isset($activities) ? $activities : ''; ?>&nbsp;</div>  
                </div>
                <div class="clear"></div>
                <h1 class="page-header" style="padding: 0px;">Part IV. Type of Admissions</h1>
                <h3 class="line">12) Admission option: for students who submit Standardized Test Score.</h3>
                <div class="clear line">
                    <div class="line tab1" style="width: 100%; padding: 0px;">
                        <input type="checkbox" <?php echo isset($gpa_opt_1) && $gpa_opt_1 == '1' ? 'checked="checked"' : ''; ?>/> I have an academic record of CGPA of 3.00 or 70%.
                    </div>
                </div>
                <div class="clear">
                    <div class="line tab2" style="width: 260px;padding: 0px;">Indicate your CGPA/GPX</div>
                    <div class="input" style="width: 70px;"><?php echo isset($gpa_opt_1_gpa) ? $gpa_opt_1_gpa : ''; ?>&nbsp;</div>
                </div>
                <div class="clear">
                    <div class="line tab1" style="width: 100%;padding: 0px;">
                        <input type="checkbox" <?php echo isset($gpa_opt_1) && $gpa_opt_1 == '1' ? 'checked="checked"' : ''; ?>/> I have an academic record of CGPA of 2.70 to 2.99. 
                    </div>
                </div>
                <div class="clear">
                    <div class="line tab2" style="width: 260px;padding: 0px;">Indicate your CGPA/GPX</div>
                    <div class="input" style="width: 70px;"><?php echo isset($gpa_opt_2_gpa) ? $gpa_opt_2_gpa : ''; ?>&nbsp;</div>
                    <div class="line tab1" style="width: 260px;padding: 0px;">GPA in Mathematics</div>
                    <div class="input" style="width: 70px;"><?php echo isset($gpa_opt_2_math) ? $gpa_opt_2_math : ''; ?>&nbsp;</div>
                    <div class="line tab2" style="width: 260px;padding: 0px;">GPA in Physics</div>
                    <div class="input" style="width: 70px;"><?php echo isset($gpa_opt_2_phy) ? $gpa_opt_2_phy : ''; ?>&nbsp;</div>
                </div>
                <div class="clear">
                    <div class="line tab1" style="width: 100%;padding: 0px;">
                        <input type="checkbox" <?php echo isset($is_standard_test) && $is_standard_test == '1' ? 'checked="checked"' : ''; ?>/> I have a standardize test scores on the following subjects. 
                    </div>
                </div>
                <div class="clear line">
                    <div class="line table_box center" style="width: 97px;height: 40px;">Standardized <br/>test score</div>
                    <div class="line table_box center" style="width: 200px;height: 40px;">Types of test taken</div>
                    <div class="line  table_box table_box_r center" style="width: 379px;height: 40px;">Scores/Grades</div>

                    <div class="line table_box center" style="width: 97px;height: 140px;">
                        English proficiency
                    </div>
                    <div class="line table_box" style="width: 190px;height: 140px; padding-left: 10px;">
                        <input type="checkbox" name="english_test" value="TOEFL" <?php echo isset($english_test) && $english_test == 'TOEFL' ? 'checked="checked"' : ''; ?>>
                        TOEFL* <br/>
                        <input type="checkbox" name="english_test" value="IELTS" <?php echo isset($english_test) && $english_test == 'IELTS' ? 'checked="checked"' : ''; ?>>
                        IELTS*   <br/>
                        <input type="checkbox" name="english_test" value="SAT" <?php echo isset($english_test) && $english_test == 'SAT' ? 'checked="checked"' : ''; ?>>
                        SAT <small>(Critical Reading)</small><br/>
                        <input type="checkbox" name="english_test" value="TU-GET" <?php echo isset($english_test) && $english_test == 'TU-GET' ? 'checked="checked"' : ''; ?>>
                        TU-GET<br/>
                        <input type="checkbox" name="english_test" value="CU-TEP" <?php echo isset($english_test) && $english_test == 'CU-TEP' ? 'checked="checked"' : ''; ?>>
                        CU-TEP<br/>
                        <input type="checkbox" name="english_test" value="O-NET" <?php echo isset($english_test) && $english_test == 'O-NET' ? 'checked="checked"' : ''; ?>>
                        O-NET <small>(English)</small>
                    </div>
                    <div class="line  table_box table_box_r center" style="width: 369px;height: 140px; padding-left: 10px;">
                        <div class="line">
                            <input type="checkbox" <?php echo isset($english_test) && $english_test == 'O-NET' ? 'checked="checked"' : ''; ?>>Paper-based 
                            <input type="checkbox" <?php echo isset($english_test) && $english_test == 'O-NET' ? 'checked="checked"' : ''; ?>>Paper-based 
                            <input type="checkbox" <?php echo isset($english_test) && $english_test == 'O-NET' ? 'checked="checked"' : ''; ?>>Paper-based 
                        </div>

                        <div class="clear">
                            <div class="line" style="width: 70px;">Overall</div>
                            <div class="input" style="width: 90px;"><?php echo isset($english_test_overall) ? $english_test_overall : ''; ?>&nbsp;</div>
                            <div class="clear"></div>
                            <div class="line tab1" style="width: 110px;">Writing</div>
                            <div class="input" style="width: 90px;"><?php echo isset($english_test_writing) ? $english_test_writing : ''; ?>&nbsp;</div>
                            <div class="line" style="width: 70px;">Reading</div>
                            <div class="input" style="width: 90px;"><?php echo isset($english_test_reading) ? $english_test_reading : ''; ?>&nbsp;</div>
                            <div class="clear"></div>
                            <div class="line tab1" style="width: 110px;">Speaking</div>
                            <div class="input" style="width: 90px;"><?php echo isset($english_test_speaking) ? $english_test_speaking : ''; ?>&nbsp;</div>
                            <div class="line" style="width: 70px;">Listening</div>
                            <div class="input" style="width: 90px;"><?php echo isset($english_test_listening) ? $english_test_listening : ''; ?>&nbsp;</div>
                            <div class="clear"></div>
                            <div class="line" style="width: 100px;">Date Taken</div>
                            <div class="input" style="width: 90px;"><?php echo isset($english_test_date) ? $english_test_date : ''; ?>&nbsp;</div>
                        </div>


                    </div>

                    <div class="line table_box boder_l center" style="width: 97px;height: 110px;">
                        Sciences
                    </div>
                    <div class="line table_box" style="width: 105px;height: 110px; padding-left: 10px;">                        
                        <input type="checkbox" name="science_test" value="SAT" <?php echo isset($science_test) && $science_test == 'SAT' ? 'checked="checked"' : ''; ?>>
                        SAT <br/>
                        <input type="checkbox" name="science_test" value="GCE_O" <?php echo isset($science_test) && $science_test == 'GCE_O' ? 'checked="checked"' : ''; ?>>
                        GCE’O level    <br/>
                        <input type="checkbox" name="science_test" value="GCE_A" <?php echo isset($science_test) && $science_test == 'GCE_A' ? 'checked="checked"' : ''; ?>>
                        GCE’A level  <br/>
                        <input type="checkbox" name="science_test" value="GED" <?php echo isset($science_test) && $science_test == 'GED' ? 'checked="checked"' : ''; ?>>
                        GED <br/><input type="checkbox" name="science_test" value="AP" <?php echo isset($science_test) && $science_test == 'AP' ? 'checked="checked"' : ''; ?>>
                        AP
                    </div>
                    <div class="line table_box" style="width: 75px;height: 110px; padding-left: 10px; border-left: 0px;">                        
                        <input type="checkbox" name="science_test" value="SAT_II" <?php echo isset($science_test) && $science_test == 'SAT_II' ? 'checked="checked"' : ''; ?>>
                        SAT II<br/>
                        <input type="checkbox" name="science_test" value="GCSE" <?php echo isset($science_test) && $science_test == 'GCSE' ? 'checked="checked"' : ''; ?>>
                        GCSE  <br/>
                        <input type="checkbox" name="science_test" value="IGCSE" <?php echo isset($science_test) && $science_test == 'IGCSE' ? 'checked="checked"' : ''; ?>>
                        IGCSE<br/>
                        <input type="checkbox" name="science_test" value="IB" <?php echo isset($science_test) && $science_test == 'IB' ? 'checked="checked"' : ''; ?>>
                        IB<br/>
                        <input type="checkbox" name="science_test" value="ACT" <?php echo isset($science_test) && $science_test == 'ACT' ? 'checked="checked"' : ''; ?>>
                        ACT
                    </div>
                    <div class="line  table_box center table_box_r" style="width: 379px;height: 110px; ">
                        <div class="clear" style="margin-bottom: 10px;float: left;">
                            <div style="width: 68px; float: left; padding: 0 2px;">
                                <div class="line" style="width: 68px; text-align: center;">Overall<br/>&nbsp;</div>
                                <div class="input" style="width: 68px;"><?php echo isset($science_test_overall) ? $science_test_overall : ''; ?>&nbsp;</div>
                            </div>
                            <div style="width: 83px; float: left; padding: 0 2px;">
                                <div class="line" style="width: 83px; text-align: center;">Math/<br/>Calculus AB</div>
                                <div class="input" style="width: 83px;"><?php echo isset($science_test_math) ? $science_test_math : ''; ?>&nbsp;</div>
                            </div>
                            <div style="width: 68px; float: left; padding: 0 2px;">
                                <div class="line" style="width: 68px; text-align: center;">Physics B<br/>&nbsp;</div>
                                <div class="input" style="width: 68px;"><?php echo isset($science_test_phy) ? $science_test_phy : ''; ?>&nbsp;</div>
                            </div>
                            <div style="width: 72px; float: left; padding: 0 2px;">
                                <div class="line" style="width: 72px; text-align: center;">Chemistry<br/>&nbsp;</div>
                                <div class="input" style="width: 72px;"><?php echo isset($science_test_chem) ? $science_test_chem : ''; ?>&nbsp;</div>
                            </div>
                            <div style="width: 68px; float: left; padding: 0 2px;">
                                <div class="line" style="width: 68px; text-align: center;">Biology<br/>&nbsp;</div>
                                <div class="input" style="width: 68px;"><?php echo isset($science_test_bio) ? $science_test_bio : ''; ?>&nbsp;</div>
                            </div>
                        </div>
                        <div class="line" style="width: 100px;">Date Taken</div>
                        <div class="input" style="width: 90px;"><?php echo isset($science_test_date) ? $science_test_date : ''; ?>&nbsp;</div>


                    </div>

                    <div class="line table_box table_box_b center" style="width: 97px;height: 120px;">
                        Thai National Admission
                    </div>
                    <div class="line table_box table_box_b" style="width: 190px;height: 120px; padding-left: 10px;">                        
                        <?php
                        if (isset($admission_test)) {
                            $admission_selected = explode('|', $admission_test);
                        }
                        ?>
                        <input type="checkbox" name="admission_test[]" value="O-NET" <?php echo isset($admission_test) && in_array('O-NET', $admission_selected) ? 'checked="checked"' : ''; ?>>
                        O-NET<br/>
                        <input type="checkbox" name="admission_test[]" value="A-NET" <?php echo isset($admission_test) && in_array('A-NET', $admission_selected) ? 'checked="checked"' : ''; ?>>
                        A-NET   <br/>
                        <input type="checkbox" name="admission_test[]" value="GAT" <?php echo isset($admission_test) && in_array('GAT', $admission_selected) ? 'checked="checked"' : ''; ?>>
                        GAT<br/>
                        <input type="checkbox" name="admission_test[]" value="PAT 1" <?php echo isset($admission_test) && in_array('PAT 1', $admission_selected) ? 'checked="checked"' : ''; ?>>
                        PAT 1<br/>
                        <input type="checkbox" name="admission_test[]" value="PAT 2" <?php echo isset($admission_test) && in_array('PAT 2', $admission_selected) ? 'checked="checked"' : ''; ?>>
                        PAT 2
                    </div>

                    <div class="line  table_box center table_box_r table_box_b" style="width: 379px;height: 120px; ">
                        <div class="clear" style="float: left;">
                            <div style="width: 72px; float: left; padding: 0 2px;">
                                <div class="line" style="width: 72px; text-align: center;">O-NET<br/>&nbsp;</div>
                                <div class="input" style="width: 72px;"><?php echo isset($admission_test_onet) ? $admission_test_onet : ''; ?>&nbsp;</div>
                                <div class="input" style="width: 72px;">Date:<br/><?php echo isset($admission_test_onet_date) ? $admission_test_onet_date : ''; ?>&nbsp;</div>
                            </div>
                            <div style="width: 72px; float: left; padding: 0 2px;">
                                <div class="line" style="width: 72px; text-align: center;">A-NET<br/>Sciences</div>
                                <div class="input" style="width: 72px;"><?php echo isset($admission_test_anet) ? $admission_test_anet : ''; ?>&nbsp;</div>
                                <div class="input" style="width: 72px;">Date:<br/><?php echo isset($admission_test_anet_date) ? $admission_test_anet_date : ''; ?>&nbsp;</div>
                            </div>
                            <div style="width: 72px; float: left; padding: 0 2px;">
                                <div class="line" style="width: 72px; text-align: center;">GAT<br/>&nbsp;</div>
                                <div class="input" style="width: 72px;"><?php echo isset($admission_test_gat) ? $admission_test_gat : ''; ?>&nbsp;</div>
                                <div class="input" style="width: 72px;">Date:<br/><?php echo isset($admission_test_gat_date) ? $admission_test_gat_date : ''; ?>&nbsp;</div>
                            </div>
                            <div style="width: 72px; float: left; padding: 0 2px;">
                                <div class="line" style="width: 72px; text-align: center;">PAT 1<br/>Math</div>
                                <div class="input" style="width: 72px;"><?php echo isset($admission_test_pati) ? $admission_test_pati : ''; ?>&nbsp;</div>
                                <div class="input" style="width: 72px;">Date:<br/><?php echo isset($admission_test_pati_date) ? $admission_test_pati_date : ''; ?>&nbsp;</div>
                            </div>
                            <div style="width: 71px; float: left; padding: 0 2px;">
                                <div class="line" style="width: 71px; text-align: center;">PAT 2<br/>Sciences</div>
                                <div class="input" style="width: 71px;"><?php echo isset($admission_test_patii) ? $admission_test_patii : ''; ?>&nbsp;</div>
                                <div class="input" style="width: 71px;">Date:<br/><?php echo isset($admission_test_patii_date) ? $admission_test_patii_date : ''; ?>&nbsp;</div>
                            </div>
                        </div>


                    </div>
                    <h3>* Remark : English standard test score, if qualified, can be submitted for exception from EL 171 English Course II and EL 172 English Course III.</h3>

                    <div class="clear"></div>
                    <h1 class="page-header">Part V. Additional Information <small>(This part does not affect your application result)</small></h1>
                    <div class="clear line_no_padding">
                        <h3 class="line">13) From which source did you learn about Science Programs at Thammasat University?</h3>
                        <?php
                        if (isset($sources)) {
                            $sources_selected = explode('|', $sources);
                        }
                        ?>
                        <div class="clear"></div>
                        <div class="line" style="width: 180px;"><input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('1', $sources_selected) ? 'checked="checked"' : ''; ?>/>Our visit to your school</div>
                        <div class="line" style="width: 294px;"><input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('2', $sources_selected) ? 'checked="checked"' : ''; ?>/>Newspaper or magazine (please specify)</div>
                        <div class="input" style="width: 205px;"><?php echo isset($sources_specify_1) ? $sources_specify_1 : ''; ?>&nbsp;</div>

                        <div class="clear"></div>
                        <div class="line" style="width: 180px;"><input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('3', $sources_selected) ? 'checked="checked"' : ''; ?>/>Parents or relatives</div>
                        <div class="line" style="width: 200px;"><input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('4', $sources_selected) ? 'checked="checked"' : ''; ?>/>Exhibition (please specify)</div>
                        <div class="input" style="width: 299px;"><?php echo isset($sources_specify_2) ? $sources_specify_2 : ''; ?>&nbsp;</div>

                        <div class="clear"></div>
                        <div class="line" style="width: 180px;"><input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('5', $sources_selected) ? 'checked="checked"' : ''; ?>/>Friends</div>
                        <div class="line" style="width: 200px;"><input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('6', $sources_selected) ? 'checked="checked"' : ''; ?>/>Website (please specify)</div>
                        <div class="input" style="width: 299px;"><?php echo isset($sources_specify_3) ? $sources_specify_3 : ''; ?>&nbsp;</div>

                        <div class="clear"></div>
                        <div class="line" style="width: 180px;"><input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('7', $sources_selected) ? 'checked="checked"' : ''; ?>/>Our students</div>
                        <div class="line" style="width: 309px;"><input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('8', $sources_selected) ? 'checked="checked"' : ''; ?>/>TV or radio advertisement (please specify) </div>
                        <div class="input" style="width: 190px;"><?php echo isset($sources_specify_4) ? $sources_specify_4 : ''; ?>&nbsp;</div>

                        <div class="clear"></div>
                        <div class="line" style="width: 180px;"><input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('9', $sources_selected) ? 'checked="checked"' : ''; ?>/>Our alumni</div>
                        <div class="line" style="width: 250px;"><input type="checkbox" name="sources[]" value="1" <?php echo isset($sources) && in_array('10', $sources_selected) ? 'checked="checked"' : ''; ?>/>Other sources (please specify)</div>
                        <div class="input" style="width: 249px;"><?php echo isset($sources_specify_5) ? $sources_specify_5 : ''; ?>&nbsp;</div>

                        <div class="clear">
                            <h3 class="line">14) Please list names of other school/ university that you are applying or plan to apply to:</h3>
                        </div>
                        <div class="clear"></div>
                        <div class="line tab1" style="width: 70px;">1)</div>
                        <div class="input" style="width: 269px;"><?php echo isset($another_school_1) ? $another_school_1 : ''; ?>&nbsp;</div>
                        <div class="line tab1" style="width: 70px;">2)</div>
                        <div class="input" style="width: 270px;"><?php echo isset($another_school_2) ? $another_school_2 : ''; ?>&nbsp;</div>
                        <div class="clear"></div>
                        <div class="line tab1" style="width: 70px;">3)</div>
                        <div class="input" style="width: 269px;"><?php echo isset($another_school_3) ? $another_school_3 : ''; ?>&nbsp;</div>
                        <div class="line tab1" style="width: 70px;">4)</div>
                        <div class="input" style="width: 270px;"><?php echo isset($another_school_4) ? $another_school_4 : ''; ?>&nbsp;</div>

                        <div class="clear">
                            <h3 class="line" style="width: 100%;">15) How would you like this program to improve in order to serve you better? Your suggestions are welcome.</h3>
                            <div class="input" style="width: 100%;"><?php echo isset($suggestions) ? $suggestions : ''; ?>&nbsp;</div>  
                        </div>
                    </div>

                    <div class="clear"></div>
                    <h1 class="page-header">Part VI. Documentation and application fee</h1>
                    <h3 class="line">Please enclose required and supporting documents and the application fee with this application.</h3>
                    <div class="clear">
                        <div class="line" style="width: 282px; height: 40px;">
                            <strong>Required documents</strong><br>
                            <small style="font-size: 11px;">Mark the box(s) indicating the material you enclosed. </small>
                        </div>
                        <div class="line box-color center" style="width: 58px; height: 40px;">
                            <label class="center"><small>Boxes for official use only</small></label>
                        </div>
                        <div class="line" style="width: 282px; height: 40px;">
                            <strong>Required documents</strong><br>
                            <small style="font-size: 11px;">Mark the box(s) indicating the material you enclosed. </small>
                        </div>
                        <div class="line box-color center" style="width: 58px; height: 40px;">
                            <label class="center"><small>Boxes for official use only</small></label>
                        </div>
                        <div class="clear"></div>
                        <div class="line line_no_padding" style="width: 282px; height:  300px;">
                            <?php
                            if (isset($required_doc)) {
                                $required_doc_selected = explode('|', $required_doc);
                            }

                            if (isset($required_doc_staff)) {
                                $required_doc_staff_selected = explode('|', $required_doc_staff);
                            }
                            ?>
                            <div class="line" style="width: 20px;padding-top: 4px;"><input type="checkbox" name="required_doc[]" value="1" <?php echo isset($required_doc) && in_array('1', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                            <div class="line" style="width: 260px;">3 recent 1-inch photographs</div>
                            <div class="clear"></div>

                            <div class="line" style="width: 20px;padding-top: 4px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('2', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                            <div class="line" style="width: 260px;">A photocopy of the applicant’s citizen ID /or A photocopy of passport for foreign applicant</div>
                            <div class="clear"></div>

                            <div class="line" style="width: 20px;padding-top: 4px;"><input type="checkbox" name="required_doc[]" value="3" <?php echo isset($required_doc) && in_array('3', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                            <div class="line" style="width: 260px;">A photocopy of transcript of academic record from high school attended /or A photocopy of certificate or diploma earned</div>
                            <div class="clear"></div>

                            <div class="line" style="width: 20px;padding-top: 4px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('4', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                            <div class="line" style="width: 260px;">A photocopy of house registration (for Thai only)</div>
                            <div class="clear"></div>

                            <div class="line" style="width: 20px;padding-top: 4px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('5', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                            <div class="line" style="width: 260px;">A certificate of equivalence issued by the Ministry of Education, Thailand. 
                                (Required for applicants graduating from international school.)</div>
                            <div class="clear"></div>

                        </div>
                        <div class="line box-color center" style="width: 58px;height:  300px;">  
                            <div class="line clear center" style="height: 8px;">
                                <input type="checkbox" name="required_doc_staff[]" value="1" <?php echo isset($required_doc_staff) && in_array('1', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?>>
                            </div>
                            <div class="line clear center" style="height: 48px;">
                                <input type="checkbox" name="required_doc_staff[]" value="2" <?php echo isset($required_doc_staff) && in_array('2', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?>>
                            </div>
                            <div class="line clear center" style="height: 73px;">
                                <input type="checkbox" name="required_doc_staff[]" value="3" <?php echo isset($required_doc_staff) && in_array('3', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?>>
                            </div>
                            <div class="line clear center" style="height: 32px;">
                                <input type="checkbox" name="required_doc_staff[]" value="4" <?php echo isset($required_doc_staff) && in_array('4', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?>>
                            </div>
                            <div class="line clear center" style="height: 22px;">
                                <input type="checkbox" name="required_doc_staff[]" value="5" <?php echo isset($required_doc_staff) && in_array('5', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?>>
                            </div>
                        </div>
                        <div class="line line_no_padding" style="width: 282px;height:  300px;">
                            <strong>Original score report of Standardized Test Scores</strong>
                            <div class="clear"></div>
                            <div class="line" style="width: 141px; ">
                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('6', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">SAT</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('7', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">GCE’O level</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('8', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">GCE’A level</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('9', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">GED</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('10', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">AP</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('11', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">O-NET</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('12', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">PAT-1</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('13', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">PAT-2</div> 
                                <div class="clear"></div>
                            </div>

                            <div class="line" style="width: 141px;">
                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('14', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">SAT II</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('15', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">GCSE</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('16', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">IGCSE</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('17', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">IB</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('18', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">ACT</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('19', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">A-NET</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('20', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">GAT</div> 
                                <div class="clear"></div>
                            </div>
                            <div class="clear"></div>
                            <strong>Original score report of English proficiency</strong>
                            <div class="line" style="width: 141px;">
                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('21', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">TOEFL </div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('22', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">IELTS</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('23', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">SAT </div> 
                                <div class="clear"></div>
                            </div>
                            <div class="line" style="width: 141px;">
                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('24', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">TU-GET</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('25', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">CU-TEP</div> 
                                <div class="clear"></div>

                                <div class="line" style="width: 20px;"><input type="checkbox" name="required_doc[]" value="2" <?php echo isset($required_doc) && in_array('26', $required_doc_selected) ? 'checked="checked"' : ''; ?>></div>
                                <div class="line" style="width: 121px;">O-NET</div> 
                                <div class="clear"></div>
                            </div>
                            <div class="clear"></div>

                        </div>
                        <div class="line box-color center" style="width: 58px;height:  300px;">  
                            <div class="line clear center" style="height:  190px;">
                                <input type="checkbox" name="required_doc_staff[]" value="1" <?php echo isset($required_doc_staff) && in_array('6', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?>>
                            </div>
                            <div class="line clear center">
                                <input type="checkbox" name="required_doc_staff[]" value="2" <?php echo isset($required_doc_staff) && in_array('7', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?>>
                            </div>
                        </div>
                        <div class="line" style="width: 435px;">
                            <h3>Application fee 500 Bahts (see INSTRUCTION FOR APPLICATION)</h3>
                            <label>***All photocopies must be certified by the applicant.</label>
                        </div>
                        <div class="line" style="width: 72px;">
                            <input type="radio" name="payment_type" value="cash" <?php echo isset($payment_type) && $payment_type == 'cash' ? 'checked="checked"' : ''; ?>>
                            Cash
                        </div>
                        <div class="line" style="width: 115px;">
                            <input type="radio" name="payment_type" value="money order" <?php echo isset($payment_type) && $payment_type == 'money order' ? 'checked="checked"' : ''; ?>>
                            Money order
                        </div>
                        <div class="line box-color center" style="width: 58px;">  
                            <div class="line clear center" style="">
                                <input type="checkbox" name="required_doc_staff[]" value="1" <?php echo isset($required_doc_staff) && in_array('8', $required_doc_staff_selected) ? 'checked="checked"' : ''; ?>>
                            </div>
                        </div>
                        <div class="line" style="border: 1px solid black; margin: 0 30px; padding: 10px 20px; font-size: 12px;">
                            <strong>Notes:</strong> The Programs do not accept unofficial copies of test results. Only the ORIGINAL score reports are
                            acceptable. The tests must be dated within two years(after January 1, <?php echo date('Y') - 2; ?>.)

                        </div>

                        <div class="clear"></div>
                        <h1 class="page-header">Part VII.  Declaration and signature</h1>
                        <h3 class="line tab1">I certify that all the information provided by me is true and complete. I understand that deliberately giving fault information will lead to nullification of my admission.</h3>
                        <h3 style="text-align: center; margin-top: 40px;">Signature:_________________________________________________ Date: _______/_______ /_______</h3>
                    </div>

                </div>
            </div>

    </body>
</html>